HEALTH CARE

Hospitals see spike in indigents

BY LORETTA SWORD
THE PUEBLO CHIEFTAIN

Published: November 18, 2013;Last modified: November 18, 2013 08:38AM

Although uncompensated and charity care at both hospitals has held steady for the past year or so, those figures jumped drastically at Parkview Medical Center between 2011-12. Then in fiscal 2013 (each fiscal year ends in June), Medicaid compensation rose nearly as drastically.

Parkview Chief Financial Officer Bill Patterson said it could be that many Southern Coloradans have moved from the “self-pay” or “uninsured” category to the Medicaid rolls.

Medicaid patients are included in the “charity care” category because reimbursement rates “aren’t even close” to true costs, Patterson explained.

Even so, each penny from Medicaid is better than no payment at all, he said.

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Uncompensated care in Parkview’s emergency room was $40 million in 2011, but jumped to $49 million in 2012 and leveled out at $48 million for 2013, Patterson said.

During the same time frame, annual Medicaid compensation went from $100 million in 2011 to $123 million in 2012 and $151 million for the fiscal year that ended in June.

Aside from Medicaid patients, Patterson said that half of the hospital’s uncompensated care goes to uninsured of self-pay patients and the rest to patients who couldn’t afford their copays and deductibles.

He said that population has grown since insurance companies and businesses agreed to keep premiums and coverage levels stable by increasing the out-of-pocket costs of premium holders.

With no way to project how many more Southern Coloradans will qualify for Medicaid under relaxed guidelines that are part of federal health reform, or how many will be able to buy private insurance with federal premium subsidies, Patterson’s budget projections for the current fiscal year and the following year are based on an assumption that charity care will be about the same as it was in fiscal 2013.

More Medicaid patients and privately insured patients would be a positive, for sure, but Patterson said all hospitals know they’re going to take cuts in Medicare reimbursements next year.

He said the cuts are the government’s way to avoid overpaying after so many formerly indigent patients are newly insured either through Medicaid or private insurance.

Those cuts could be significant, Patterson said, because Pueblo and surrounding areas are home to so many patients who are poor, or both elderly and poor, that both local hospitals get extra compensation through Medicare for providing that care. In other words, Medicare pays more per procedure or service here than in areas with fewer uninsured and elderly patients.

“We get 12 percent ‘add on’ (in Medicare reimbursement) because of the area’s high poverty level and the number of elderly, he said, adding that the hospital receives another 5.5 percent on top of straight reimbursement rates because it provides a disproportionate amount of services to self-pay and Medicaid patients.

The changes that health reform will bring “could turn out really well, or it could be awful, or it could be a wash” for Parkview, Patterson said. “There’s no way to even guess right now.”

Vanessa Kochevar, CFO at St. Mary-Corwin Medical Center, said the hospital’s unpaid emergency room patient volume this year is “consistent with the previous two years” but no specific figures were available.

Kochevar said the hospital anticipates that a portion of current nonpaying patients “should gain coverage either through Medicaid or with subsidized insurance” under the Affordable Care Act.